Thursday, August 15, 2013

Disruptive Physicians . . . and How to Deal with Them

How to deal with disruptive physician's
How to Deal with Disruptive Physician Behavior
This post is sponsored by The Journal of Medical Practice Management ®
Everyone has a bad day - even a bad week - now and then. How can you tell when you have a real problem on your hands? Seasoned consultant Randy Bauman, from Delta Healthcare Consulting, brings his years of experience to the thorny issue of physicians who simply “don’t play well with others.”
Many group practices have physician behavior issues, most of them minor. But sometimes the behavior is so bad it truly becomes disruptive - that is, threatening the success and well being of the practice.

He suggests asking these five questions:
  1. Would I tolerate this behavior in any other staff member?
  2. If I acted this way, how would I expect my colleagues to react?
  3. Would I want to try and explain this physician’s behavior during a deposition?
  4. Is this physician’s behavior damaging either my personal or my practice’s reputation?
  5. If this physician left the practice, how would it affect our group dynamics?
Associate physicians, practice leaders, and administrators tend to look the other way, tolerating behavior in a physician that would bring about the summary dismissal of any other staff member. Practice leaders often delay dealing with horrible behavior because they fear confrontation with a strong personality - or with a big revenue producer!

What lies at the root of disruptive behavior? Often one of the following factors manifests in conduct that goes way beyond “annoying”:
  • Hobbled self-awareness, social skills, or emotional intelligence;
  • Arrogance, egotism, and narcissism;
  • Perfectionism and obsessive tendencies;
  • Loss of prestige or respect among fellow professionals;
  • Disappointment in time commitment, finances, and professional satisfaction;
  • Burnout and disenchantment;
  • Personal problems—for example, at home;
  • False bravado masking insecurity; or
  • True pathology—that is emotional, psychiatric, or addiction issues.
Do not confuse merely annoying mannerisms and habits with truly disruptive behavior. The behavior that must be addressed is that behavior that threatens and damages the practice, such as:
  • Refusing to adhere to accepted standards and policies;
  • Being chronically late and disorganized;
  • Having an unprofessional appearance and demeanor that puts off patients and support staff;
  • Ducking fair share of work and responsibility;
  • Refusing to keep up to date or to learn and grow in professional knowledge and continuing education;
  • Being argumentative—the “never wrong” syndrome;
  • Airing complaints and “internal” issues to patients and outside parties;
  • Using derogatory, foul, and crude language;
  • Exhibiting explosive temper tantrums or wide mood swings;
  • Threatening violence or legal action against colleagues, staff, business associates, or patients; 
  • Sexually harassing or using crude/offensive humor; and
  • Demonstrating unethical, illegal, unscrupulous, or otherwise immoral behavior.
Before the group is damaged irreparably - before bad morale starts costing you in employee turnover, lost referrals, and reluctant patients

and payors - determine when and how to intervene. Bauman offers six do’s and six don’ts that your group should incorporate into your policy immediately:
  • DO act promptly.
  • DO tell it like it is.
  • DO lay out clear expectations for improvement.
  • DO document your discussions and actions.
  • DO specify consequences for noncompliance.
  • DO schedule follow-up meetings and monitor progress.
  • DON’T ignore the issue.
  • DON’T beat around the bush.
  • DON’T be intimidated or charmed.
  • DON’T make empty threats.
  • DON’T get in over your head without professional help (especially with physician impairment or legal issues such as sexual harassment).
  • DON’T take a passive-aggressive approach by trying to implement new rules that address the problem behavior indirectly.
Two final nuggets of advice: First, take a proactive approach. Establish a code of conduct to which all physicians will subscribe if they want to be members of your group, and draw up a written procedure for dealing with disruptive behavior. Finally, bringing in a consultant as a neutral advisor can help ensure fairness in the intervention process and increase chances of a real conclusion with a positive outcome.

photo credit: caricaturas via photopin cc